NEW YORK The real issue here is (and always has been) the inclusion of diabetes supplies as part of durable medical equipment under Medicare Part D billing. That’s because diabetes equipment is considered a part of DME, the same as walkers and canes, motorized wheelchairs and oxygen supplies. And that doesn’t look likely to change. It's unfortunate.
Because the real fact of the matter is, retail pharmacy — be it in rural or urban America, be it a community pharmacist, national/regional chain or supermarket pharmacy — retail pharmacy is more and more geared to better serve the diabetes patient than perhaps any other healthcare provider.
It’s one-stop shopping — diabetes patients can pick up their pharmaceuticals in the same location as they replenish their test-strips and lancets, and in the case of Type 1 diabetics, their insulin and syringes. Further, it’s one-stop shopping under the wise eye of a readily accessible healthcare professional — even if the particular pharmacist has not received specialized training around diabetes, a factor that is becoming less and less likely, that pharmacist certainly has the wherewithal to advise their patients around whatever question they may have, and to at least point them in the right direction.
Are you going to find that licensed and authoritative healthcare professional in your average DME specialty shop? And if you could, would there really be a drive to get all DME providers accredited and bonded?
What’s becoming more and more likely is that the pharmacist in question either is or actually works with a certified diabetes educator. More and more likely also is that pharmacist works with a nutritionist. In other words, the number of community pharmacies that offer services to diabetics above and beyond placing their strips and lancets into a shopping bag is growing. And it’s continuing to grow.
But unlike other healthcare providers, and despite the likelihood that the average pharmacist has received some level of accredited education around diabetes over the course of their career, licensed pharmacists still have to become accredited if they’re to serve their Medicare patients. And they need to get a surety bond — a bond put into play in an effort to reduce Medicare fraud. Never mind the fact that if an independent pharmacist or chain pharmacy is found guilty of bilking CMS, they’ve most likely just placed their entire business model in jeopardy with their respective state-sanctioned board of pharmacy.
But perhaps the biggest issue here, one that CMS, as the largest healthcare payor across the country, has not really wrapped their minds around, is that maintaining access to those diabetes supplies in a pharmacy setting saves healthcare payors money. And for CMS, that really should be the paramount issue as well. For Congress, it’s already a paramount issue.
That’s the whole reason why this bill was drafted and passed and now sits on the President’s desk. And it’s the whole reason why many Congressional advocates of the value behind pharmacy are also looking to actually change the rules, so that the already-licensed pharmacies can continue serving their patients, diabetic or otherwise, without having to pursue a redundant and cost-intensive accreditation process.